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Regional Training Networks: time to connect the pieces?

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The Australian health system has long existed in a state of medical maldistribution, a consequence of the challenge of recruiting and retaining doctors in the bush.

Successive governments have implemented a range of policies to improve distribution, ranging from rural clinical schools and mentoring scholarships to much-maligned bonding schemes and provider number moratoriums.

While many vocational training programs have requirements for regional rotations (the General Practice training program being one shining example), the majority of these efforts currently focus on undergraduate students and doctors who have completed their vocational training.

It’s often said that the greatest barrier to doctors-in-training being able to train in, and develop links with, regional communities is a distinct lack of access to quality, regionally-based training between graduation and the commencement of a vocational training program.

It’s no secret that these are the years in which young doctors establish professional and social networks that will heavily influence their future likelihood of working in regional areas.

With the surge in junior doctors moving through the medical training pipeline, many of whom have a rural background, or who have completed part of their training in regional universities and rural clinical schools, now is the time to get moving on this issue.

The idea of enhanced linkages between regional health system structures is not new, with many existing rural clinical schools having strong local links.

Current rural medical generalist training pathways similarly involve the development of strong regional linkages during vocational training, and there exist a number of Integrated Regional Clinical Training Networks, an initiative of Health Workforce Australia, which link together undergraduate training providers of clinical placements.

The opportunity now is to connect new and existing training pathways such that doctors-in-training, and especially undifferentiated prevocational doctors, have access to a quality, coherent pathway for embarking upon training in a regional area – ideally from medical school through vocational training.

Whereas current ‘secondment’ arrangements involve trainees being based primarily in cities and rotating out to regional areas, could we develop networks of regional training sites that are able to rotate their trainees in to metropolitan hospitals?

With trainees who wish to be there, and feel they have a home in their regional location, the potential benefits to trainees and regional health services alike are significant.

No doubt there are a number of challenges to overcome before regional training networks will simply spring up out of the woodwork.

Funding is forever a driver of health system behaviour, so funding and governance models will need to be developed which are sustainable for providers of training, at no disadvantage to trainees.

While undergraduate regional rotations have a reputation for excellent clinical experience, prevocational trainees will want to be assured of adequate supervision and high quality in their training. They will also want to know that training in a regional location will not put them at a disadvantage in the competition for vocational training places.

The broader question is how widely applicable a model of regionally-based training will be for different regions and specialties. We can see the positive effects of regionalised General Practice training, but will this work for other training programs and in all regions?

While there is welcome evidence that the rural clinical school model is encouraging junior doctors to practice in the bush, the reliance on coercive bonded workforce schemes to achieve short-term fixes will likely continue until greater coordination of regional medical training is achieved.

Given the opportunity before us, advocating for greater vertical geographic integration would be a positive move for doctors-in-training, and for the sustainability of Australia’s health system.

Regional Training Networks will be discussed at the upcoming AMA Trainee Forum on 15 March in Melbourne. For more information, contact the Council of Doctors-in-Training via bholden@ama.com.au